Refugees are at a strikingly elevated risk of suffering from post-displacement mental disorders, with severe implications for social and occupational functioning while increasing the burden and costs of mental health and social services. Studies have identified pre-displacement individuals and socio-environmental risk factors for refugee mental health. These factors, e.g., exposure to war trauma, are largely non-malleable. However, there is increasing scientific evidence of adverse mental health effects from post-displacement trauma, including violence, and marginalization. As a result, there is a need to assess the efficacy of post-displacement institutional resources, such as language and vocational training. Although significant resources are devoted to such post-displacement programs, there is a void of prospective, controlled studies examining their effectiveness in promoting refugees' mental health. The long-term goal of this research is to further our understanding of post-displacement institutional risk and resiliency factors for mental health. The overall objective of this proposal is to compare mental health over time in a random sample of newly arrived Iraqi refugees and legal Middle East immigrant controls. The central hypothesis, based on our pilot data, is that post-displacement institutional resources attenuate mental health consequences of post-displacement stress, controlling for pre-displacement trauma. The primary specific aims are to: 1) Describe the differences in mental health disorders, specifically post-traumatic stress disorder (PTSD) and depression, between newly arrived Iraqi refugees and non-war exposed Arab immigrant to the U.S. and their relationship to pre-displacement trauma; 2: Determine the relationship between pre-displacement trauma and post-displacement stressors as it relates prospectively to mental health over a 2-year period, and whether this relationship differs between refugees and immigrants; and 3: Determine the impact of post-migration institutional services on mental health and whether effects differ by group. This research is innovative in that it uses a random sampling, prospective, controlled design to study important mental health among newly arrived refugees. Our multi-disciplinary team, with excellent relationships to the Arab and Chaldean American community, will thus evaluate multiple levels of predictors of mental health: group (refugee vs. immigrant), pre- and post-displacement trauma, institutional resources (service utilization), and interactions between these factors. The expected outcome is improved understanding of the relationship between trauma, social service utilization and mental health. The project is of public health relevance in that it will examine the impact of post-migration institutional resources on refugee mental health, with implication for social and occupational integration. PUBLIC HEALTH RELEVANCE: Due to methodological limitations, studies to date have not been able to ascertain whether refugees are at a disproportionally increased risk for serious and costly mental health disorders as compared to non-war exposed immigrants. In collaboration with Arab and Chaldean community organizations, we propose to study and compare a hypothesized beneficial effect of post-displacement institutional resources, i.e., language and job training on refugee and immigrant mental health. The proposed research is substantially relevant to public heath both in contributing new and generalizable knowledge of relationships between pre and post- displacement factors, institutional resources and mental health in refugees, and also in its capacity to inform the development of cost-effective, beneficial mental health resettlement policies.